Cuadernos de Bioetica最新文献

Organic Law 3/2021, of March 24, regulating euthanasia, has intensified a harsh debate. A priori, it is a conflict of bioethical values and a different anthropological vision between the different parties, however, we must not forget that perhaps before considering any debate, it is necessary to correctly interpret what the patient really wants when he states that he wants to die. In our health system and in our society, there are certain traits and needs of the person that are ignored, and that urgently require attention for the patient. Discovering the meaning of one's life, considering human transcendence, finding personal order and being able to experience love are vital elements of life, which at such a critical moment as high-grade suffering or imminent death, require all the attention of the health personnel. All this can contrast sharply with the values of our society, not dedicating adequate attention to it, among other reasons, due to the effort involved in carrying out comprehensive care of this type, thus making it much easier to carry out the procedures required by law regulation of euthanasia than addressing such intimate deficiencies of the being, despite the fact that these may be the real problem of the patient, who in his dramatic experience asks for help.

Nowadays, medicine tends towards specialization. But there are also more shared or interdisciplinary processes in which professionals request some type of technique or a diagnostic or therapeutic procedure that must performed by another specialist. In this scenario that involves different professionals, it is reasonable a certain debate about which of them should obtain the informed consent of the patient. The first error would be to pose this process as a confrontation between professionals who derive or delegate their own responsibilities to another. It is, on the contrary, a teamwork and not a mere delegation of duties. On the one hand, it should be the doctor who carries out the technique and, therefore, knows it best as a procedure and is an expert in the early diagnosis and management of side effects, who should inform about the procedure and its risks. And, therefore, it is his duty to obtain the appropriate informed consent. And, since everything is understood as a shared process, it would also be advisable that the physician in charge of the care and follow-up of the patient, and who has taken the initiative to request this technique, had already provided basic information, more focused on the reason for the indication, and that a pre-consent had been obtained, that is a prior elementary verbal consent of acceptance or, at least, of non-rejection. And it would be convenient to record this information in the medical record as well.

Renal dysfunction is common and can be severe in patients requiring cardiac surgery. There is currently a growing international interest in the declaration of Safe Health Units, around the safety of the surgical patient. This interest is influenced at the same time by utilitarianism and the defense of the great value of human life. The general objective was to analyze, from the bioethics of health care and the contents of surgical patient safety, acute kidney injury associated with cardiac surgery. A systematic review was carried out using the PRISMA methodology in PubMed databases with articles published in the last five years. The pathophysiology of the entity studied is complex and still poorly understood. In this period, there was a great interest in investigating acute kidney injury associated with cardiac surgery, however, no other studies were found that addressed this issue from a personalist bioethical approach. High scientific quality and methodological rigor were found in the included studies, assessed by the predominance of systematic reviews, meta-analyses, and multicenter, randomized, double-blind controlled studies. An interesting and novel field is initiated, which facilitates, from perspectives with a comprehensive and more humane assessment, decision-making on acute kidney injury associated with cardiac surgery.

It seems beyond doubt that the practice of certain sports requires gender differentiation, given the sexlinked characteristics that determine different levels of performance and skills. Moreover, there is a consensus on condemning doping practices, such as attempts to artificially alter the physical performance of athletes through the use of certain substances, because they involve tampering with the physical or mental conditions of the persons involved, as well as practices that have health risks, with consequences that can become serious and irreversible. In the case of ″trans″ athletes, their genetics, physiology, and endocrine system, responsible for typically male testosterone levels, would provide an insurmountable barrier to their eligibility in female athletic competition. However, the case of athletes diagnosed with Disorders of Sex Development does not fit into any of the above scenarios. They are biologically women and competes in the female category. They have not taken any anabolic substances that may be considered doping. We propose a bioethical evaluation of these cases.

This article aims to explore the bioethical problems that are concentrated around the Umbilical Cord Blood. The publication in the year 2020 in Spain of the new National Umbilical Cord Blood Plan recalls the current status of the issue. The bioethical problems of umbilical cord blood have not been specially studied, rather there are few studies in this regard and above all they have focused on the controversy over its autologous use and its storage in private banks. This work, the result of reading twenty-six institutional statements from the most diverse institutions in different countries, offers a detailed and systematic enumeration of the bioethical problems that arise around the life of umbilical cord blood and proposes, fundamentally, a classification with an evolutionary criterion, that is, following the course of the Umbilical Cord Blood, from its donation to its use, passing through the problems of donors and storage. The sources used cover a period from 1998 to 2019 and are practically all the existing ones. This work offers a conclusive analysis of a synchronic nature, in which the bioethical constants are detected in the 31 years analyzed, specifically the principles of autonomy and solidarity, in addition to the so-called bioethics of expectations; and another of a diachronic nature in which the bioethical nuclei in which the questions are concentrated stand out: the lack of personalistic principles and the conflict between freedom and solidarity.

The aim of this article is to explore John Henry Newman's reflections on the meaning of the medical profession in a lecture to medical students in Dublin. Specifically, it will show how Newman's exposition of what we have called the ″medical fallacy″ allows us to consider him as an authoritative interlocutor in the debate on the naturalistic fallacy and the indefinition of the good, led by David Hume and Georg Edward Moore. Thus, in times of COVID-19, euthanasia and emotivism, delving into the thought of the English author can contribute to illuminating the bioethical problems of our time.

Until 2020, only Belgium, Luxembourg, Switzerland, and the Netherlands admitted, under differentiated legal coverage, requests for euthanasia and / or assisted suicide in patients with non-terminal illnesses, and for reasons of intractable and unbearable suffering. Since March 2021 this is also possible in Spain. The objective of this work is to review the existing studies and characteristics of the practice of euthanasia and assisted suicide (ESA) in people with mental disorders (TM) and / or dementia (D) and see if the legal requirements essential in ESA applications in these patients are to be met. The hypothesis is that compliance with these requirements is especially difficult in patients with TM-D, either because of the characteristics of the disease itself, or because of the recognized legal security failures. Likewise, there may be sources of fraud not actually prosecuted by the State, either due to the complicity of society and / or due to the necessary cooperation of Medicine. As a result of this review, we raise criticaethical-deontological considerations about the approval of ESA for patients with TM-D, and its errors and consequences, to the reflection of the readers. We propose as an alternative to ESA the so-called ″palliative psychiatry″, which aims at improving the quality of life of patients and their families by facing the problems associated with severe persistent mental illness -potentially fatal- through the prevention and relief of suffering.

The pandemic caused by SARS-COVID-2 has supposed an extraordinary challenge for prisons. There is an unavoidable need to take action to stop the entry and spread of the virus, however, the measures must respect prisoners' rights and must not constitute any kind of inhuman or degrading treatment. Spanish prison authorities have published and extensive normative that has transformed life in prisons during the pandemic. We have reviewed the content of these norms, which's main treads are: no discrimination and the guarantee of an equivalent treatment than that to the regular population; coordination of medical authorities; interruption or diminution of the spread of the virus from or towards prisons; the strengthening of alternatives to closed regime sentences; mobility restriction methods inside prisons, and measures to minimise the risks employees are exposed to. In general, the measures have respected prisoners' rights. However, indefinite quarantine practices have likely violated them, being that there were other alternative measures. Ultimately, the extensive vaccination of prisoners has public health implications, constitutes an ethical imperative towards this group of vulnerable people and should be implemented promptly.

In the context of general changes in our societies in relation to health, the healthy organization is proclaimed and accepted as something necessary and legitimate. This phenomenon is expanding globally without being really questioned and promoted by international organizations and large companies. With a global and growing presence in organizational and professional policies and practices, it appears to be gaining even more strength in the aftermath of the pandemic. Faced with the expansion of the phenomenon and because it directly affects people's health, an analysis of it beyond its general positive image is unavoidable. This article identifies some relevant dangers of promoting a culture of health at work, from an ethical perspective, and among them, not only the non-beneficial nature of some practices not scientifically proven, but also their own malignant condition. In this paper, therefore, the ethical limits for this expansive phenomenon are proposed and the fundamental principle to operate in this area of asymmetric relations between employee and employer is not autonomy but non-maleficence.